The Gallbladder
The gallbladder is a small sac located just under your liver, beneath the right ribcage. It stores and concentrates bile, a greenish-brown fluid made by the liver. Bile travels from the gallbladder through the bile ducts into the small intestine, where it helps digest food, especially fats. Gallstones are small, stone-like collections of crystals that form in the bile, most commonly from cholesterol. They develop in the gallbladder and can vary in size, sometimes being as small as a grain of sand or as large as a golf ball.
Understanding Gallstones
Many people with gallstones do not have any symptoms and may not even know they have them. When symptoms occur, they can include:
- Upper abdominal pain, usually in the centre or right side of the abdomen, which can be severe, intermittent, and last for hours. It may be difficult to find a comfortable position.
- Tenderness or persistent pain under the right ribcage, sometimes triggered by fatty meals.
- Nausea, bloating, or feeling full after eating.
If gallstones move into the bile duct, more serious symptoms may develop, requiring urgent medical attention:
- Jaundice, yellowing of the skin or eyes, sometimes with dark urine or pale stools.
- Pancreatitis, inflammation of the pancreas, causing severe upper abdominal pain.
- Infection of the bile ducts (cholangitis), may cause fever, pain, and feeling unwell.
Causes & Risk Factors
Gallstones are relatively common. Around 10 to 15% of adults in the UK have gallstones, though many do not experience any symptoms. They are more likely to develop as people get older and are slightly more common in women than men. Gallstones form when substances in bile, such as cholesterol or bilirubin, become concentrated and crystallise. You may be more likely to develop gallstones if you:
- Diet and weight Following a high-fat, low-fibre diet, being overweight or obese, or experiencing rapid weight loss (e.g., after surgery) increases risk.
- Age and sex More common in people over 40 and women, especially those taking hormone therapy or contraceptive pills.
- Pregnancy Hormonal changes during pregnancy can increase the likelihood of gallstone formation.
- Family history Having close relatives with gallstones may increase personal risk.
- Medical conditions Certain conditions such as diabetes, liver disease, Crohn’s disease, or some blood disorders can raise the risk of developing gallstones.
Diagnosing Gallstones
If gallstones are suspected, tests are usually done to confirm their presence and location. These may include:
- Blood tests These can help check for complications or indicate whether stones may have moved into the bile duct.
- Ultrasound A painless scan, similar to a pregnancy scan, that can show gallstones in the gallbladder or bile ducts.
- MRI or CT scan In some cases, MRI or CT scans may be used to provide more detail. A special MRI scan called an MRCP may be carried out if needed, to view the bile and pancreatic ducts in more detail. An ERCP combines endoscopy and X-rays to diagnose and sometimes remove bile duct stones.
Treatment Options
Not all gallstones cause symptoms, and many people never need treatment. Management depends on your symptoms, overall health, and whether complications are present. There is no single treatment that suits everyone. Your doctor will discuss all available options with you and advise on what they feel is best for your individual situation.
Conservative Management
Not all gallstones need surgery. If gallstones are not causing symptoms or complications, management may focus on lifestyle changes and monitoring.
- Diet & lifestyle Eating smaller, low-fat meals can help reduce discomfort. Maintaining a healthy weight and avoiding rapid weight loss can also lower the risk of new gallstones forming.
- Medication Certain medications can slowly dissolve some types of cholesterol gallstones, but this treatment is only suitable for a small number of patients and is usually reserved for those who cannot have surgery.
Surgical Management
Gallstones usually do not disappear by themselves. If they cause symptoms or complications, surgery may be recommended to remove them.
- Laparoscopic Cholecystectomy Keyhole gallbladder removal. The most common method to remove the gallbladder, performed through a few small abdominal incisions using a camera and special instruments. Most patients go home the same day or after an overnight stay.
- Open Surgery For more complex cases, the surgeon makes a larger incision in the abdomen to remove the gallbladder. The gallbladder is carefully detached and removed, and the incision is closed with stitches. Recovery is longer than keyhole surgery, usually taking several weeks before normal activities can be resumed.